Alzheimer’s patients are one of the vulnerable groups that have been affected by confinement restrictions due to the pandemic.
Specialists have proven that the symptoms and the patient’s mood worsen and affect the cognitive and behavioral process.
“Quarantine increases behavior problems in an incredible way. It impairs the cognitive process of memory skills in the patient and precipitates quite severe depression reactions, ”said Heriberto Acosta, neurologist and scientific advisor to the Puerto Rico Alzheimer’s and Related Disorders Association.
There are studies in other countries that suggest that all these circumstances increase the mortality of these patients during this time.
“What had been seen is that this increase in mortality was specifically in patients who were in nursing homes and patients who were over 65 years old. This increase in mortality could not be related to the organic causes that one normally relates to deaths in these types of patients, “explained Acosta.
The scientists came to the conclusion that the emotional state of the patients, the lack of social relationships with other people, induced a kind of affective involution that took away their desire to live and that this became a highly significant risk factor to help produce the mortality that is being seen.
The “lockdown” of older patients has to be reassessed and studied. “I think it deserves a greater study, it deserves to see all the experiences that are happening in the whole world,” said the also scientific advisor of the Alzheimer’s Association of PR.
The healthiest stimulus that can be given to any human being, sick or not, is socio-emotional support.
This is based on giving love, support, being positive with people, showing care and concern. “I believe that from the time human beings are born until they die, this is possibly the most important stimulus for the entire central nervous system,” Acevedo indicated.
Within this stimulation, the emotion that is transmitted is more important than the words we use.
Words within this type of situation are of little value. “I can tell a person I support you, I love you very much, I am with you! But if that is not accompanied by an emotional affective manifestation, it really does not have an adequate effect ”.
Acevedo explained that this is so because the human being’s emotional system is designed for survival. The main function of this affective system is to survive. From the moment one is born until one dies, that emotional system is in force. It is much more robust, much stronger than the cognitive system that is super imposed on the cerebral cortex above all these structures that are more primitive from the evolutionary point of view ”.
This system not only helps one to make a social and festive life, but it also helps us to survive as a living being within our society. We are programmed to read, to be highly susceptible to interpreting affective manifestations.
“Sometimes one is confronted with a patient who is in an advanced stage, who is in bed, cannot speak and does not respond to almost any environmental stimulus, however, he knows how to differentiate the positive and negative affective stimulus. You can tell it through their facial expression, ”he mentioned.
The neurologist said: “I always tell all caregivers that it is much more important that you treat your family member with affection than what you say. The words in our life have no value, the true values of the people are manifested through affective action ”.
After providing that stimulus comes interaction, sensory stimuli from the environment, auditory and visual stimuli such as music.
The injection of human relationship has to be present at all times. That is daily and intense work. “The more time we dedicate to the patient, the better the result we are going to have,” he said.
“We have some windows of opportunity that are limited, after those windows of opportunity where you were supposed to give the right stimuli, they close and there is no place to go back,” he added.
Alzheimer’s is a multifactorial disease, it must be understood not only to prevent it but to eventually manage it. This disease cannot be prevented and postponed the beginning of it.
“The main factor is an increase in age, followed by family inheritance (if I have a mother, father, brother or grandfather with the disease) this can significantly increase the risk of me having the condition, high cholesterol, high blood pressure, high sugar , low vitamin levels, thyroid disorders, lack of physical exercise, not learning new things, not having enough emotional stimulation, excess stress and toxic lifestyles such as drug use ”, he explained.
All these factors are going to have an effect no matter when you have had them.
Alzheimer’s disease, which is the most common form of dementia, accounts for between 60% and 70% of cases.
According to the World Health Organization, dementia affects around 50 million people globally, of which about 60% live in low- and middle-income countries. About 10 million new cases are registered each year.
It is estimated that between 5% and 8% of the general population aged 60 and over suffer from dementia at any given time.
“The mistakes of youth take their toll after 50 years. What you do as a young man, stayed there. That is going to cause a lot of problems after that age, “he said.
Acevedo explained that to prevent it we have to create an extremely large awareness in our population, enough to create changes in lifestyles and this is very important for a simple reason. The island is forecast to have approximately 2,300,000 citizens by 2050. Of that number, there will be approximately 800,000 people over 60 years of age.
Incidence statistics indicate that 10% will suffer some type of dementia. This is a very high amount. “Who is going to take care of them, who is going to maintain the economy of this country, who is going to produce those services that are needed?”
“We have to stop and start planning for that moment. We are going to have chaos if we don’t start avoiding those risk factors, ”he said.
Diagnosis and treatment
To diagnose the disease it is important to sit down with the patient and family member to listen to them.
“One of the things that happens with most patients who have this type of problem is that they are going to tell you that they are fine,” Acosta said.
99% of patients deny all symptoms.
“It is not because they want to do it, it is a characteristic of the disease. This is known as anosognosia, ”he explained. “Every time I hear that they say they are ‘excellent well’ I can see that the patients are very poor.”
These patients lose the ability to self-evaluate and will insist that they are okay.
“They are not only memory problems, in many cases behavior problems begin to be seen very early. For example, people who were quiet become irritable, intolerable, and develop depression after age 50 for the first time for no reason. These depressions on many occasions can be the first manifestation of the disease, “said the scientific advisor.
Early detection is extremely important. “If that does not happen, the treatment will not be adequate and it will not give the expected results. The earlier the condition is suspected, the better eventually the treatment is going to be, ”she said.
When the patient has a detailed history at an early stage, lesions in the brain are looked for, the entire metabolic system is seen to corroborate if there are any risk factors that could justify all this type of behavior, cerebrovascular studies and MRI are done. “Diagnosis is a process.”
“The eventual treatment is one of trying to manage the patient from a holistic point of view and seeing all the circumstances of the patient in order to manage it,” he said.
“The first recommendation is that you do not assume that someone else is going to come and do the things that correspond to us as family members,” he mentioned.
The key point is to make people understand that they have a responsibility. “The Alzheimer’s patient is an entity with metabolic, medical, social and family needs that must be done. If we don’t do all that, we won’t be successful in improving the patient. “
On the other hand, he recommended that during the day, the family member or caregiver should do a structured routine. The patient must sleep, wake up, be bathed and fed at the same time.
“The patient has to perform memory strengthening activities with photographs and music, and do support tasks in housework,” concluded the neurologist.